Background Maternal mortality in Cameroon’s conflict-affected Northwest Region remains high, with delays in accessing and receiving emergency obstetric care (EmOC) being a major contributor. Using the Three Delays Model, this study investigated socioeconomic and health system predictors of the second delay (reaching a health facility after deciding to seek care) and third delay (receiving adequate care upon arrival) among postnatal women in referral hospitals. Methods A hospital-based cross-sectional study was conducted from June 2024 to April 2025 (11 months) among 472 postnatal women across eight high-volume public referral facilities in the Northwest Region. Data were collected using a structured, interviewer-administered questionnaire adapted from validated tools. Delays were defined using a two-stage approach: an initial screening question followed by time thresholds (> 1 h from decision to arrival for the second delay; >1 h from arrival to care for the third delay), with additional contributing barriers assessed via closed-ended yes/no questions. Univariable chi-square analysis and multivariable binary logistic regression were performed in SPSS version 25 to identify independent predictors. Statistical significance was set at p < 0.05. Results Second delay affected 124 women (26.3%) and was independently predicted by rural residence (AOR = 2.82, 95% CI: 1.79–4.45, p < 0.001), semi-urban residence (AOR = 2.04, 95% CI: 1.23–3.38, p = 0.005), and low household income (< 25,000 FCFA) (AOR = 3.46, 95% CI: 1.66–7.21, p = 0.001). Third delay affected 154 women (32.6%), with lower odds among women aged 20–29 years (AOR = 0.42, 95% CI: 0.22–0.80, p = 0.008), those aged 30–39 years (AOR = 0.51, 95% CI: 0.28–0.93, p = 0.029), married women (AOR = 0.42, 95% CI: 0.26–0.68, p < 0.001), and women earning 51,000–100,000 FCFA (AOR = 0.39, 95% CI: 0.19–0.80, p = 0.010). Self-reported barriers included staffing shortages (40.2%), poor service quality (50.8%), blood supply issues (33.9%), and long admission processes (33.7%). Conclusion Over one-quarter of women experienced delays in reaching EmOC facilities, driven by rural residence and low income, while one-third faced delays in receiving care, associated with lower odds among married women and those with moderate income. Self-reported systemic barriers, including staffing shortages, poor infrastructure, and inefficient referrals, compound socioeconomic vulnerabilities in this conflict-affected zone. Targeted interventions, such as subsidised rural transport, digital referral systems, and enhanced facility readiness, are urgently needed to reduce preventable maternal deaths and advance Cameroon’s SDG 3.1 commitments.

Second and third delays in emergency obstetric care: predictors in Northwest Cameroon

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2026年5月6日

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Tosi Jones Nkwain,
Lifoter Kenneth Navti,
Mary Bi Suh Atanga

摘要

Background

Maternal mortality in Cameroon’s conflict-affected Northwest Region remains high, with delays in accessing and receiving emergency obstetric care (EmOC) being a major contributor. Using the Three Delays Model, this study investigated socioeconomic and health system predictors of the second delay (reaching a health facility after deciding to seek care) and third delay (receiving adequate care upon arrival) among postnatal women in referral hospitals.

Methods

A hospital-based cross-sectional study was conducted from June 2024 to April 2025 (11 months) among 472 postnatal women across eight high-volume public referral facilities in the Northwest Region. Data were collected using a structured, interviewer-administered questionnaire adapted from validated tools. Delays were defined using a two-stage approach: an initial screening question followed by time thresholds (> 1 h from decision to arrival for the second delay; >1 h from arrival to care for the third delay), with additional contributing barriers assessed via closed-ended yes/no questions. Univariable chi-square analysis and multivariable binary logistic regression were performed in SPSS version 25 to identify independent predictors. Statistical significance was set at p < 0.05.

Results

Second delay affected 124 women (26.3%) and was independently predicted by rural residence (AOR = 2.82, 95% CI: 1.79–4.45, p < 0.001), semi-urban residence (AOR = 2.04, 95% CI: 1.23–3.38, p = 0.005), and low household income (< 25,000 FCFA) (AOR = 3.46, 95% CI: 1.66–7.21, p = 0.001). Third delay affected 154 women (32.6%), with lower odds among women aged 20–29 years (AOR = 0.42, 95% CI: 0.22–0.80, p = 0.008), those aged 30–39 years (AOR = 0.51, 95% CI: 0.28–0.93, p = 0.029), married women (AOR = 0.42, 95% CI: 0.26–0.68, p < 0.001), and women earning 51,000–100,000 FCFA (AOR = 0.39, 95% CI: 0.19–0.80, p = 0.010). Self-reported barriers included staffing shortages (40.2%), poor service quality (50.8%), blood supply issues (33.9%), and long admission processes (33.7%).

Conclusion

Over one-quarter of women experienced delays in reaching EmOC facilities, driven by rural residence and low income, while one-third faced delays in receiving care, associated with lower odds among married women and those with moderate income. Self-reported systemic barriers, including staffing shortages, poor infrastructure, and inefficient referrals, compound socioeconomic vulnerabilities in this conflict-affected zone. Targeted interventions, such as subsidised rural transport, digital referral systems, and enhanced facility readiness, are urgently needed to reduce preventable maternal deaths and advance Cameroon’s SDG 3.1 commitments.